CERTIFICATE OF PHYSICAL FITNESS

(To be issued by a Medical Officer)

I, Dr. (IMC. Reg. No. ), do
hereby certify that I have examined Mr./Ms.
a candidate for admission to the
National Institute of Technology, Tiruchirappalli-15 and could not discover that he/she has
any disease, constitutional affliction or bodily infirmity.

His/Her age according to his/her own statement is years and by appearance

about years.

Personal Marks of identification.

1.

2.

a. Weight b. Height

c. Chest measurement of full inspiration and expiration

d. Acuteness of vision* (in case where sight is corrected with glasses for each eye should be

noted)

e. Whether any abnormality of heart or lung?

f. Whether affected with hernia, hydeocele, vericocele, piles etc?

g. Hearing whether normal?

h. General health and build: whether good?

N.B: Any defects, deformities or other disabilities when present should be noted in detail.

Station: Signature:

Date: Name:
Seal:
(A Registered Medical Practitioner not below the rank of an Assistant Surgeon)
* Acuteness of vision: Left Eye
Right Eye
 Annexure-II
NATIONAL INSTITUTE OF TECHNOLOGY, TIRUCHIRAPPALLI-15
OFFICE OF THE ACADEMIC
DECLARATION FOR THE LATE SUBMISSION OF RELEVANT DOCUMENTS
Candidate’s Details:
Name of the Candidate
Date of Birth
CAT Registration Number
CAT Score
Qualifying Degree Passing Status Appeared / Passed
Qualifying Degree
Qualifying Degree Discipline
Mobile Number
Email id

Allotment Details

Allotted Programme MBA

Allotted Category

The following certificates are not currently available with me due to late declaration of
result/non-issuance of certificate. I undertake that I will submit the following certificate(s) on
or before 30th September 2024, failing which I shall forgo my admission at NIT
Tiruchirappalli. I aware that all exams of my qualifying degree should have been completed
by 15th August 2024. Further, I aware that I will get the stipend only after submission of the
following certificates:
1. Original Provisional / Degree certificate
2. Original Transfer Certificate/Migration Certificate
3. Original Grade / Mark Sheets
4. Any other*
Date: Signature of the Candidate

Name & Signature of the verification official

*Note: This late submission form is not applicable for CATEGORY CERTIFICATE. EWS/OBC/SC/ST
candidates should produce the required original category certificate for verification.